How Should I Treat a Patient with Severe and Symptomatic Aortic Stenosis Who is Rejected for Surgical and Transfemoral Valve Replacement and in Whom a Transapical Implantation Was Aborted?

BACKGROUND:A 74 year old male with a history of postero-lateral myocardial infarction in 1993 and coronary bypass surgery in 1994 was referred to the outpatient clinic in a frail general condition with signs of dyspnoea at rest.INVESTIGATIONS:Physical examination, electrocardiography, laboratory tests, coronary angiography, abdominal angiography, Echo-doppler, transesophageal echo.DIAGNOSIS:Aortic stenosis.MANAGEMENT:Valve replacement.